The effect of local dexamethasone on stapedotomy surgery outcomes in patients with otosclerosis.

BACKGROUND: Some studies have shown a positive effect of systemic corticosteroid on hearing results after stapedotomy, but its side effects can limit its routine administration. AIM: The aim of this study was to investigate the effect of local dexamethasone on the results of stapedotomy surgery. MATERIAL AND METHODS: Fifty two patients undergone stapedotomy surgery for otosclerosis involved. In the case group after stapedotomy we fulfilled the middle ear with dexamethasone and then the placement of the prosthesis was done. In the control group after stapedotomy we did not use dexamethasone in the middle ear. RESULTS: Gender, age, nausea, vomiting, postoperative vertigo and nystagmus did not significantly differ between the groups. A significant difference was observed in tinnitus rate between two groups. In the case group ABG decrease was higher and bone conduction thresholds improved at frequencies of 1000, 2000, and 4000 three months after surgery. CONCLUSION: Since local dexamethasone had a positive effect on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate. SIGNIFICANCE: If local dexamethasone had a positive influence on the results of stapedotomy surgery, it can be used instead of systemic corticosteroids to reduce the side effects and increasing surgery's success rate.

Primary Parotid Angiosarcoma in a 66-year-old Man Initially Presented as Cervical Lymph Node Metastasis: Pitfall Diagnosis with Review of Literature.

Angiosarcoma is a malignant vascular tumor that occurs mostly in the soft tissues, skin, trunk, and limbs. Angiosarcoma of the parotid gland is a very uncommon and rare tumor. Herein, we presented a case of a 66-year-old man who was referred for a lump in his neck and his initial biopsy reported Castleman disease. After three months during which the mass did not resolve, a re-biopsy was performed. The biopsy revealed vascular neoplasm composed of neoplastic spindle cells arranged in fascicles with extravasation of the red blood cells within the lymph node. A diagnosis of metastatic angiosarcoma was confirmed by immunohistochemical staining. The neoplastic cells were positive for vimentin, EMA, and CD31. The patient underwent radiation therapy. Nine months later, MRI (magnetic resonance imaging) showed a tumor in the parotid gland. The microscopic examination revealed a primary angiosarcoma of the parotid. Although primary angiosarcoma of the parotid gland is very rare, it should be considered as a possible origin in metastatic angiosarcoma of the neck. Further studies are recommended to more cleary define the process.

The Effect of Electrical Stimulation Therapy on Brain Derived Neurotrophic Factor in Patients with Tinnitus.

Introduction: The aim of this study was to determine the effect of electric stimulation therapy on brain-derived neurotrophic factor (BDNF) in patients with tinnitus. Materials and methods: In this before-after clinical trial study, 45 patients aged 30-80 years old with tinnitus were involved. The hearing threshold, loudness, and frequency of tinnitus were assessed. Tinnitus Handicap Inventory (THI) questionnaire was completed by the patients. Before holding electrical stimulation sessions, the patients were evaluated for serum brain-derived neurotrophic factor (BDNF) level. Patients underwent five electrical stimulation sessions of 20 min for 5 consecutive days. After completion of electrical stimulation session, THI questionnaire was re-completed by the patients and they were evaluated for serum BDNF level. Results: Mean BDNF level before and after the intervention was (1238 ± 494.2) and (1148.2 ± 496.7), respectively (P = 0.04). Mean loudness score before and after the intervention was (6.36 ± 1.47) and (5.27 ± 1.68), respectively (P = 0.01). Mean THI score before and after the intervention was (58.21 ± 11.8) and (53.17 ± 15.19), respectively (p = 0.01). In patients with severe THI1, there was a significant difference between serum BDNF level (p = 0.019) and loudness (p = 0.003) before and after the intervention. However, in patients with mild, moderate, and very severe THI1, no such effect was observed (p > 0.05). Conclusion: According to the results of the present study, electrical stimulation therapy significantly decreased the mean plasma BDNF level in patients with tinnitus, especially in patients with severe tinnitus so it can be used as a marker to define the response to treatment and determine the severity of tinnitus in primary evaluations.

The association between metabolic syndrome and the prognosis of idiopathic sudden sensorineural hearing loss.

INTRODUCTION: In this study, we investigated the association between metabolic syndrome and the prognosis of idiopathic sudden sensorineural hearing loss. METHODS: In this prospective cohort study, 79 patients with idiopathic SSNHL admitted to the ENT ward were involved. Patients were under treatment with two-dose pulse methylprednisolone and then oral corticosteroid (Prednisolone 1 mg/kg for up to 2 weeks and more). In all patients, the mean hearing threshold was measured before treatment and 3 weeks after the treatment. Metabolic syndrome criteria were assessed in all patients too. Then, based on these diagnostic criteria all data in patients with and without metabolic were compared. RESULTS: There was a significant difference in Hypertension, BMI > 25, high TG and low HDL (p.v = 0.001) between two groups (metabolic syndrome group and non-metabolic syndrome group). The rate of recovered patients was significantly lower in the metabolic syndrome group than in the non-metabolic syndrome group (p.v = 0.001). It was found that metabolic syndrome (OR = 2.02), diabetes mellitus (OR = 7.32), HTN (OR = 4.09), BMI > 25 (OR = 3.24) and high initial hearing threshold (OR = 3.96) were clearly related to the poor prognosis of treatment. CONCLUSIONS: According to the findings of this study, it was found that metabolic syndrome had a negative effect on hearing improvement in patients with idiopathic SSNHL.

Investigating the possible association between thyroid nodule location and the malignancy risk of the nodules in FNA samples.

INTRODUCTION: In this study we aimed to investigate the association between thyroid nodule location and the malignancy risk of the nodules in FNA samples. METHODS: In this cross sectional study, 400 patients with thyroid nodule size >1.5 cm, thyroid nodule size >1 cm with micro-calcification, and thyroid nodule size <1 cm with sonographic or clinical signs of malignancy who referred to a training hospital, were involved. Morphologic characteristics of nodules, including nodule size, laterality and polarity were recorded. In patients with multinodular goiter, the anatomical location was recorded and analyzed. RESULTS: In our study, 345 female patients (86.3 %) and 55 male patients (13.8 %) with thyroid nodule were involved. The majority of thyroid nodules were identified in the right lobe (n = 182, 45.5 %) and left lobe (n = 177, 44.3 %), respectively. A total of 323 nodules were benign and the remaining (n = 77) were malignant. The frequency of malignancy in the upper pole of the thyroid (31.6 %) was higher compared to that in the middle pole (10.7 %), lower pole (19.1 %), and isthmus region (26.8 %), leading to a significant difference (p.value = 0.001). The mean size of thyroid nodules was 15.68 mm in benign nodules and 20.08 mm in malignant nodules. CONCLUSION: Our results showed that thyroid nodules found in the upper lobe carried the greatest risk for malignancy. Accordingly, it seems that the location of thyroid nodules can be an independent risk factor in determining the malignancy risk of thyroid nodules and can be used to enhance clinical decision making in thyroid FNA samples.

Comparing the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children.

INTRODUCTION: In this study we aimed to compare the efficacy of peritonsillar injection of bupivacaine and intravenous acetaminophen on post-tonsillectomy pain in children. MATERIALS AND METHODS: In this randomized double-blind clinical trial study 60 children with ASA = I-II aged 5-12 years undergoing tonsillectomy were involved. The first group received bupivacaine at a dose of 0.1 mg/kg that was injected into the bed and the anterior crease of each tonsil. The second group was given intravenous acetaminophen at a dose of 12.5 mg/kg. The patient's pain score at 10, 30, 60 min after his/her admission to recovery room and 120, 240 and 360 min after the surgery was recorded using CHEOPS. Patient's sedation score, nausea or vomiting, the time of the first request for analgesia and the time of starting oral feeding were recorded and analyzed too. RESULTS: There was no significant differences in mean age (p value = 0.44), gender (p value = 0.79), weight (p value = 0.36), height (p value = 0.17), anesthesia duration (p.value = 0.85) and surgery duration (p.value = 0.73) between two groups. Postoperative pain was significantly less in the bupivacaine group at 240 and 360 min after the surgery. The mean sedation score was higher in the bupivacaine group but not significantly. There was no significant difference between groups regarding the nausea and vomiting, the first analgesics request time and the start time of oral feeding. CONCLUSION: According to the results of the present study, since administration of peritonsillar bupivacaine compared to acetaminophen had a better effect on managing postoperative pain and improving sedation and also since no complications were reported; therefore, peritonsillar infiltration with bupivacaine is suggested for pediatric tonsillectomy.

Cyclin D1 Expression in Patients with Laryngeal Squamous Cell Carcinoma.

BACKGROUND & OBJECTIVE: Laryngeal squamous cell carcinoma (LSCC) is considered to be one of the most common cancers of the head and neck, accounting for roughly 90% of all malignant tumors of the larynx. To have a timely diagnosis for a better and practical therapy, molecular markers have to be investigated. The aim of this study was to determine the expression of Cyclin D1 (CD1) in patients with laryngeal squamous cell carcinoma. METHODS: In this study the demographic data of 82 patients with laryngeal squamous cell carcinoma, including age, gender and geographical region history of smoking and drug abuse, paraclinical findings, surgical description, and pathologic reports were extracted from their medical records. The stage and grade of the disease and tumor location were determined using their medical records. An appropriate tissue sample was selected. Then, the selected cancerous tissue samples stored as formalin-fixed paraffin-embedded tissue then were (Immunohistochemistry) IHC stained and analyzed in terms of the expression of CD1. RESULTS & CONCLUSION: According to the results, 75 out of 82 (91.5%) investigated samples were positive for CD1 expression. There was a significant relationship between stage of the disease (P=0.041) and CD1 expression in patients with laryngeal squamous cell carcinoma. There was no significant relationship between gender (P=0.055), age (P=0.256), history of smoking and drug abuse (P=0.192), location of the tumor (P=0.90), grade of the disease (P=0.515) and geographical region (P=0.466) and CD1 expression in patients with laryngeal squamous cell carcinoma. The results of the present study showed that CD1 expression was higher (91.5%) in patients with laryngeal squamous cell carcinoma in comparison to the other studies. According to the results we can conclude that stage of the disease can significantly affect CD1 expression in patients with squamous cell carcinoma.

Changes in elastic properties of the nasal tip using Columellar strut graft versus tongue-in-groove method over one year after rhinoplasty.

INTRODUCTION: In this study, we decided to investigate the changes in elasticity of the nasal tip using Columellar strut graft versus toung in groove method over a year after rhinoplasty. MATERIALS AND METHODS: In this before-after randomized clinical trial study, 44 candidates for rhinoplasty were enrolled Columellar strut graft group (n = 22) and toung in groove group (n = 22). Also 22 patients who referred to ENT clinic without any previous rhinoplasty and without any decision for it during the next year, considered as control group. One group underwent columellar strut graft and the other one underwent tongue in groove rhinoplasty and in control group participants received no intervention. Nasolabial angle and elasticity of the nasal tip were recorded and compared before the surgery, immediately after the surgery, 3 months and one year after the surgery. RESULT: There was no significant difference between the mean elasticity of the nose and the nasolabial angle before the surgery, immediately after the surgery and 3 months after the surgery between the groups. However, there was significant differences in the mean elasticity of the nose and the nasolabial angle between the groups one year after the surgery (P value < 0.05). Pearson correlation coefficient test showed a significant correlation between nasal tip elasticity 3 months and 1 year after rhinoplasty (P = 0.032, r = 0.459) and nasolabial angle 3 months and 1 year after rhinoplasty (P = 0.045, r = 0.431). CONCLUSION: According to the results, it can be concluded that the both the Columellar strut graft and toung in groove methods improve elastic properties of the nasal tip and nasolabial angle after rhinoplasty compare to the control group.

The Effect of Gelfoam Impregnated With Botulinum Toxin on Allergic Rhinitis.

INTRODUCTION: This study evaluated the effect of gelfoam impregnated with botulinum toxin on the symptoms induced by allergic rhinitis. MATERIALS AND METHODS: In total, 30 patients with allergic rhinitis who did not respond to common therapies were included in this clinical trial study. All patients were treated with intranasal gelfoam impregnated with botulinum toxin type a (40 unit in each side) placed in the middle meatus of each nostril. The main symptoms of allergic rhinitis were scored from zero to three by the patients. Symptoms recorded and compared before and two months after the treatment. RESULT: The mean age of patients was 31.03±6.9 years. The mean score for sneezing was 2.23 before the treatment which significantly decreased to 1.06 after the treatment (P<0.05). The mean scores of rhinorrhea, nasal congestion, and nasal itching were 2.53, 2.03, and 1.93, respectively, before the treatment which significantly decreased to 0.93, 1, and 0.8 after the treatment (P<0.05). No reported side effects was observed in this study. CONCLUSION: According to the results, treatment with gelfoam impregnated with botulinum toxin is an effective and safe method in patients who have not responded to common therapies for allergic rhinitis. Accordingly, it is recommended to relieve symptoms in patients with seasonal allergic rhinitis in order to maintain the effectiveness of this treatment at least 8 weeks.

Effect of Cold Diet and Diet at Room Temperature on Post-Tonsillectomy Pain in Children.

INTRODUCTION: The present study aimed to compare the effect of cold diet and diet at room temperature on post-tonsillectomy pain in children. MATERIALS AND METHODS: In the present study a total of 120 children within the age range of 4-12 years who underwent tonsillectomy were randomly assigned to two groups, namely group C with a cold-served diet and group room temperaturewith a room-temperature-served diet postoperatively. Each patient's post-operative pain was evaluated using the Face, Legs, Activity, Cry, Consolability (FLACC) scale prior to oral diet initiation after the operation, before thesecond acetaminophen dose, before the next day breakfast, and before discharge. RESULTS: Out of 103 children, 48 and 55 children were femaleand male, respectively. The average age of the children was 7 years and 2 months. There was no significant difference in gender and age between the two groups. There were no significant differences in the mean scores of FLACC scale between the two groups at different times, including before starting an oral diet (P>0.15), before the second dose of acetaminophen (P>0.22), before the next day breakfast (P>0.32), and before discharge (P>0.83). In terms of bleedingfrequency, as well as nausea and vomiting, no significant difference was observed between the two groups. CONCLUSION: The obtained results of this study indicated that using cold liquids and foods after tonsillectomy did not have a significant effect on post-tonsillectomy pain in children. According to the findings, it is not rational to advise the mother or the child about the temperature of fluids and foods consumed post-tonsillectomy.

Comparison of Accuracy of Subjective Measurement of Tip-Supra Tip Difference During Rhinoplasty Between Plastic Surgeons.

INTRODUCTION: This study compared the subjective measurement of difference between the nasal tip and supra tip (TSD) (using eyes) versus objective measurement of TSD (by a ruler) during rhinoplastic surgery to determine the accuracy of subjective measurements among surgeons with varying degrees of experience. MATERIALS AND METHODS: In this analytical observational study, 40 cosmetic rhinoplasty candidates were involved. Those with the history of rhinoplastic surgery were excluded from the study. At the end of the operation, the surgeon was asked to estimate the TSD subjectively. The researcher, without the intervention of the surgeon, remeasured TSD by a presterile ruler. The researcher recorded both objective and subjective TSD measurements and the experience of the surgeon in rhinoplasty in the checklist. RESULT: Of 40 cosmetic rhinoplasty candidates, 17 were operated by a surgeon with >10 years' experience (group 1), and 23 by a surgeon with <5 years' experience (group 2). The results indicated that 5 surgeries (29.4%) in group 1 and 6 surgeries (26.1%) in group 2, had 0-mm difference in subjective and objective measurement. The difference of <1 mm between subjective and objective measurement was achieved in 13 surgeries (76.5%) in group 1 and 13 surgeries (56.5%) in group 2 (P = 0.191). CONCLUSION: According to the results, it can be concluded that the surgeon's experience is effective in reducing the differences in measurements of TSD in both measurement modes.

Changes in Nasal Tip and Lateral Nostril Characteristics After the Semi-Tongue-in-Groove Technique in Open Rhinoplasty Surgery.

INTRODUCTION: This study aimed to evaluate postsurgical changes of nasal tip and lateral nostril characteristics after semi-tongue-in-groove (TIG) technique in open rhinoplasty surgery. MATERIALS AND METHODS: This prospective observational study was performed in a before-after setting on 22 patients who underwent open rhinoplasty surgery using semi-TIG technique. Postoperative photographs were analyzed for nasal tip and lateral nostril changes at several time points (1, 4, and 12 weeks after surgery) and were compared with preoperative photographs. Nasal tip support change after the surgery was also assessed using a purpose-designed device. RESULTS: In total, 22 patients were studied (20 females, 2 males). The tip support increased by 98%, 291.8%, and 377% at certain time points after the surgery. The tip rotation increased significantly at all measuring time points, postoperatively. The length of upper lip increased at all time points after semi-TIG technique. Columellar show and nostril length and height decreased significantly after the surgery. CONCLUSION: The characteristics of the nasal tip and lateral nostrils along with nasal tip support showed significant improvement after the semi-TIG technique. Therefore, this technique is recommended in selected rhinoplasty cases to achieve more favorable objective results.

The relationship between endoscopic and radiologic findings and olfactory status of patients with chronic rhinosinusitis with nasal polyps before and after the endoscopic sinus surgery.

INTRODUCTION: This study was attempted to investigate the relationship between radiologic and endoscopic findings and pre- and post-operative olfactory scores in chronic rhinosinusitis with nasal polyps. MATERIALS AND METHODS: In this study, 40 patients aged 19-64 years with chronic rhinosinusitis with nasal polyps (CRSwNP) undergoing endoscopic sinus surgery were involved. The patients' olfactory status was evaluated using Smell Identification Test (Iran SIT) before and 3 months after the surgery. Patients' nasal endoscopic signs were recorded using Modified Lund-Kennedy scoring system before and 3 months after the surgery and radiological symptoms were recorded based on Lund-Mackay CT scoring before the surgery. Then the relationship between olfactory status and endoscopic and radiological findings was investigated. RESULTS: With respect to mean of olfactory score, a significant difference was observed before and after the surgery (p value = 0.001). There was a significant difference between means of pre- and post-operative endoscopy scores (p value = 0.001). Pre-operative endoscopic and CT scan scores had a negative correlation with pre- and post-operative olfactory scores (p value < 0.05). Pre-op. olfactory scores had negative correlation with post-op. endoscopy scores (p value = 0.02). Post-op. olfactory scores had negative correlation with post-op. endoscopy scores but was not statistically significant (p value = 0.22). CONCLUSION: Our results revealed that pre-operative endoscopy and radiology findings were consistent with the olfactory status of patients with CRSwNP before and after endoscopic sinus surgery.

The Effect of Spreader Graft and Mattress Suture Technique on Rhinoplasty in Patients With Nasal Hump Smaller Than 3 mm.

INTRODUCTION: Rhinoplasty is a common plastic surgery that potentially has some complications such as postoperative deformities and breathing problems. A humpy nose is among the main reasons for rhinoplasty. Nasal valve (the narrowest part of the nasal airway) collapse may be occurred after nasal hump removal. Spreader graft is essential after more than 3 mm nasal hump removal. But the value of this graft is unknown for patients with nasal hump smaller than 3 mm. Mattress suture is another technique for widening the nasal valve angle. This study compares the effects of spreader graft and mattress suture technique on postoperative deformity and nasal valve patency in patients with nasal hump smaller than 3 mm as compared with control group (no graft and suture). METHODS: In this clinical trial study 210 patients who underwent rhinoplasty with 2 different techniques involved. Their postoperative deformity and nasal valve patency were evaluated by subjective (questionnaire and digital photography) method before and after rhinoplasty during 6 months follow-up. RESULTS: Statistically, nasal obstruction had no significant difference before and after rhinoplasty and no significant difference was observed between spreader graft and mattress sutures (P > 0.05), but significantly better results than control group (P < 0.05). CONCLUSION: In this study the results of nasal valve patency of 2 techniques were similar. Because of several considerations in spreader graft technique such as needing to septoplasty in this technique even in patients without septal deviation that causes longer surgical duration, excessive blood loss, it is recommended to use Mattress suture in patients with nasal hump smaller than 3 mm.

Comparing nasal packing with trans-septal suturing following septoplasty: a randomized clinical trial.

It has been shown that nasal packing after septoplasty is associated with several complications. Our aim was to compare post-septoplasty nasal packing and trans-septal suturing, in terms of complications and outcome of operation. This randomized clinical trial was performed on patients with deviated nasal septum who were candidates for septoplasty. Patients were visited three times after operation (on the first 48 h, first week, and third post-operative month). Participants were checked for having common complications. Rhinomanometric evaluation was performed to measure nasal air flow and airway resistance, as indicators of operation efficacy, both prior to and after surgery. A total of 72 patients were allocated into the two trial arms. Patients in nasal pack group reported higher pain scores on the first 48 h (P < 0.001) and one week after surgery (P < 0.001). Epiphora (P = 0.028), sleep disturbance (P = 0.012), and dyspnea (P < 0.001) were also more commonly observed in patients using nasal pack. Objective evaluation of bleeding demonstrated that more severe bleeding occurred in patients with trans-septal sutures (P = 0.001). No differences were found comparing the indices of rhinomanometry between the two groups. Using trans-septal sutures after septoplasty compared to nasal packing, might be associated with lower frequencies of several specific complications and a lower rate of patients' discomfort. Nevertheless, increase in the risk of bleeding and hematoma was noted in the trans-septal suture group. No differences were observed between the nasal air flow and resistance of patients in the two groups.

The comparison of bleeding and pain after tonsillectomy in bipolar electrocautery vs cold dissection.

OBJECTIVE: Although tonsillectomy is one of the most common surgeries performed in pediatric, it has potential major complications such as pain and bleeding. This study aimed to compare the bleeding and pain after tonsillectomy in bipolar electrocautery tonsillectomy versus cold dissection. METHODS: This double blind clinical trial was conducted on 70 pediatric patients who were candidate of tonsillectomy. Patients were divided into two groups of including bipolar cautery (BC) and cold dissection (CD). operation time, intraoperative blood loss, and postoperative bleeding and pain were evaluated in the current study. RESULTS: In both of the CD and BC groups, no significant difference was found in terms of sex and age. The average amount of the intraoperative blood loss in BC group was 14.086 ± 5.013 ml and in CD group was 26.14 ± 4.46 ml (p. v = 0.0001). The mean time of operation in BC group was 19 ± 2.89 min and in CD group was 29.31 ± 5.29 min (p. v = 0.0001). patients were evaluated in terms of pain on the first, third, fifth, and seventh days after the operation. No statistically significant difference was found between two groups. Moreover, Compared pain scores in all times across two groups, no significant difference was found. In terms of postoperative bleeding, none of the patients in both groups had bleeding during follow-up. CONCLUSION: Our study showed that bipolar electrocautery tonsillectomy can significantly reduce the operation time and intraoperative blood loss; however, postoperative pain and blood loss were similar in both techniques. We recommend bipolar electrocautery as the most suitable alternative method for tonsillectomy, especially in children.

Investigating the Prevalence of Human Papilloma Virus in Squamous Cell Carcinoma of the Larynx and Its Correlation with Disease Prognosis.

INTRODUCTION: The human papilloma virus (HPV) can play a role in the development of head and neck squamous cell carcinoma (SCC). Our aim was to assess the prevalence of HPV DNA in SCC of the larynx. The impact of HPV infection on patient survival was also evaluated. MATERIALS AND METHODS: This case-control study was performed in 44 patients with SCC of the larynx (case group), while the control group comprised samples obtained from cadavers with no previous history of malignancy. A preliminary pathologic evaluation was performed on all samples in the control group (36 samples) to ensure the absence of dysplasia or malignancy. Polymerase chain reaction (PCR) was used to detect HPV DNA. After completing the treatment protocol, patients were followed to assess the impact of HPV infection on overall survival (OS). RESULTS: PCR evaluation in the case group showed that HPV DNA was successfully isolated from 11 (25%) samples, while only two (5.6%) HPV DNA-positive were obtained from cadavers. According to these results, a significant difference was obtained in the prevalence of HPV DNA and laryngeal SCC between cases and controls (P=0.031). No statistically significant difference was observed in the OS of patients with or without HPV infection in the case group (P=0.235). CONCLUSION: Based on these results, we suggest that the prevalence of HPV infection is higher in laryngeal SCC subjects compared with healthy individuals. Although a longer OS was seen in HPV-positive patients, survival analysis did not show a significant difference in the comparison of HPV-positive and negative findings in SCC patients.